Sunday, 15 February 2015

This morning I was sent this piece by a colleague, from the Scottish Left Review, Issue 70, May/June 2012: 'Prozac Nationalism' by Siobhan Tolland, and thought it very pertinent for now:"Prozac Nationalism,Written by Siobhan Tolland

In 2010, the Scottish Government quietly abandoned its
commitment to reduce antidepressant use within Scotland. The original
commitment came amidst a wave of concern and worry that ten per cent of
Scots were taking antidepressants, and the SNP promised to promote
alternative treatments. Recommending this abandonment, the Scottish
Governent Audit Committee suggested that the reduction commitment did
not reflect the complexity of treatment options within Scotland.
Importantly, it argued, recent research concluded most GPs were
prescribing appropriately anyway. Thus concerns over the high use of
antidepressants within Scotland were unfounded.

At present the mental health strategy, Towards a Mentally Flourishing Scotland,
is under review, but the abandonment of that commitment is a cause for
concern. And abandoning it on the basis of the Aberdeen University
research is extremely concerning for it accepts a very controversial
view of mental illness that reduces complex emotions to a single
biomedical cause. Depression, for instance, is caused by chemical or
biological abnormalities of the brain, and should be treated
accordingly. Accepting the study’s conclusion that GPs were prescribing
appropriately then means they also accept Depression is biomedical in
origin. As a consequence, it promotes antidepressant medication above,
say, counselling, CBT or even exercise.

The biomedical view additionally prevents any social analysis of
unhappiness or desperately low mood, and medicalises these problems. It
ignores the correlation between poverty, inequality and poor mental
health, for instance. Research suggests that poor mental health is
caused by poverty, for instance, with Bristol University suggesting that
as many as 50 per cent of people in poverty have signs of depression.
Reverting to a biomedical discourse of poor mental health prevents these
social and economic connections from being established, siting
responsibility on the individual’s biology, and not society. And thus
any sense of collective social responsibility for our health and welfare
is abandoned. We don’t need to change society to make it more mentally
healthy, we just need doctors and scientists manipulate the brain.

The SNP’s change in strategy is important then because the biomedical
discourse moves away from a social analysis of health. It is also often
seen as a discourse that is of considerable benefit to the
pharmaceutical industry. There was a 234 per cent rise of
antidepressants between 1992 and 2002, for instance, and this has
steadily increased since then. The pharmaceutical industry’s profit has
risen accordingly, outstripping most other industries in terms of median
profit. The industry is staggeringly massive, the Guardian
newspaper comparing their size to ‘behemoths’, ‘outweighing entire
continents’. ‘Big Pharma’ (as they are often called) has promoted and
pushed antidepressant medication continuously, facilitated by the
biomedical discourse. That the Scottish Government accepts current
antidepressant use as ‘appropriate’ then shows a strategy more in
alignment with industry’s needs than those who need mental health
support.

This alignment with industry is actually disturbing when we consider
that the actual usefulness of antidepressant medication is under
question. The Scotland Action on Mental Health (SAMH) study, for
instance, stated that around 50 per cent of people found medication did
not actually improve their mood, and that 60 per cent of people reported
side effects from the most common antidepressant type (SSRIs), when
taking it and when trying to withdraw. More generally, Joanna Moncreiff,
Psychiatrist and critic of the ‘chemical cure’ states that the
biomedical origin of depression is a myth and that the only reason
medication works is because they put people in a chemically-induced
altered state that suppresses or masks emotional problems.
Antidepressant medication does not really solve the issues of Depression
then. At best they mask people’s feelings through drugs.Worse, the side effects reported by SAMH are severe, including
anxiety, anger and even violence. Some critics even accuse this
medication of being dangerous, and point to thousands of deaths caused
by such drugs. A very public example of this was Glaxo Smith Kline which
was accused of withholding important clinical trial information
regarding the high likelihood of under-18s having suicidal thoughts when
taking Seroxat. Some independent trials suggested the suicide risk was
up to six times higher than normal. It was suspected that such
information was withheld for nearly a decade. One ex Pharmaceutical
industry chemist suggests that we have a billion dollar industry making a
lot of people sick and profiting from it. Antidepressant medication as
‘appropriate’ treatment is a statement that should be treated with
extreme caution then. Something the Scottish Government clearly has not
done.

Behind the Aberdeen University study then lie a lot of question marks
over their assumed truths of antidepressant medication. As a result the
Scottish Government’s acceptance should be seriously questioned. The
fact that the side effects of these drugs are so common and sometimes so
terrible seemed to have no impact on the study’s conclusion or the
Scottish Government in accepting it. It seems that antidepressant
medication does not actually support or help people with poor mental
health, but merely serves to put people into a drug-induced state. This
ultimately functions as a form of social control because it prevents any
serious questioning of the system that causes such poor mental health
in the first place.

Given the controversy over antidepressants then, it seems strange
that the Scottish Government saw no relevance in the fact that two
authors of the Aberdeen University study were on the payroll of various
drugs companies as speakers or consultants. Objectivity in such research
is often questioned because of the considerable influence the industry
exerts over it. In such medical research one-third of writers have
substantial financial interest in their published work, through
sponsorships consultancies and general payments by the industry. Indeed,
a lot of the time the industry doesn’t need to offer financial
incentives because they ghost-write over half of all publications about
medication. Financial interest and profit skews a lot of medical
research and there is often not even a pretence of objectivity. It is
this influence that the Scottish Government is rigorously trying to
encourage, as it entices Big Pharma into Scotland and open NHS research
up to that influence.

Since the opening of the Scottish Parliament, the lobbying
organisation of the pharmaceutical industry (the ABPI) set up camp in
Scotland and has continuously lobbied the government. ‘Big Pharma’ has
the biggest political lobbying budget in Washington and spends more on
marketing and advertising than they do on research and development. The
ABPI is open about creating ‘foot soldiers’ within important areas such
as support groups and sympathetic health professionals to weaken the
political and ideological defences. And their presence in Scotland has
initiated a political and cultural change that transforms science and
health care to meet the needs of the industry. SNP’s change in policy
regarding antidepressant medication highlights this influence.

SNP’s policy change reflects a wider financial strategy to bring more
of the industry in to Scotland. In 2007, the Government announced a
55-acre Bio-quarter project beside the Edinburgh Royal Infirmary, as
site of excellence in Life Sciences research. Attracting investment was
one of the key objectives and the pharmaceutical industry now sits in
the grounds of the hospital and research facilities. The next year, the
Scottish Life Sciences Advisory Board (SLCAB ) was set up. This was a
joint government, academic and industry initiative to develop innovation
and growth within the life sciences (of which the drug industry makes
up seventy per cent). This has led to government initiatives, grants and
a close working relationship between the health minister and the ABPI,
determining policy and future initiatives according to the needs of Big
Pharma.

More worrying, by 2011 the SNP was openly promising to open NHS
Research Scotland up to the pharmaceutical industry. This involved a
mission to double the economic contribution of life sciences and
accelerate growth with an emphasis on business and institutional
collaboration. Promoting health seems pretty absent against this
language of business interest. One example of such a promise was a joint
partnership with companies carrying out clinical trials which involved
streamlining the ‘regulatory approval processes’, meeting the open
demands of the ABPI. Since Psychiatry and Neuroscience are proposed
areas for NHS Research/industry development, the biomedical influence of
mental health and illness seems pretty inevitable. Certainly the
interests of industry will be higher up the agenda than ever before, as
health becomes business and profit.

As the SNP prepares for the vote on independence then, it has been
busily trying to develop the economic and financial future of Scotland.
Life Sciences is one area where the SNP has seen an opportunity to
develop wealth, making Scotland a viable independent economy. And it
seems to be working. Scotland is bucking the European trend by
attracting more drug industry investment in clinical trials, for
instance. There is a real worry, however, that in the mission for
independence, we have become lured by the promise of wealth and the
might of Big Pharma.

The consequences of allowing the drugs industry this level of control
over our mental health is terrifying, as SNP’s promotion of alternative
treatment becomes less compatible with Big Pharma’s interests. Donald
Trump’s permission to have a practically free reign over parts of
northern Scotland has been met with incredulity and even horror.
Allowing Big Pharma control within our health sector, however, has been
met with very little opposition or even analysis within Scotland. The
ABPI makes it clear: treating poor health is irrelevant if it cannot
meet the needs of shareholders. And we are allowing this industry
control over our mental health.